Three-Month Durability of Bilateral Two-Level Stellate Ganglion Blocks in Patients with Generalized Anxiety Disorder: A Retrospective Analysis

Abstract

Purpose: Determine if performing ultrasound-guided, bilateral, two-level cervical sympathetic chain blocks (2LCSB) (performed on subsequent days) provides durable improvement in symptoms associated with anxiety. Methods: A retrospective chart review was conducted between January 2022 and November 2024. We identified 114 patients who received bilateral, 2LCSB for anxiety symptoms. Generalized Anxiety Disorder 7-Item Scale (GAD-7) outcome measure scores were collected at baseline and three-months post procedure in 71 males and 43 females. Results: Out of 114 patients, 99 patients (86.8%) showed a long-lasting improvement in their GAD-7 scores. Collected GAD-7 forms had a baseline average of 15.52 (14.99 for males and 16.40 for females), which decreased after three months to an average of 7.28 (6.96 for males and 7.81 for females). This represents a 52% average improvement in anxiety symptoms. Conclusions: In individuals treated with bilateral, 2LCSB, GAD-related symptoms were improved by 52% for at least 3 months regardless of initial anxiety severity.

Keywords: 2LCSB; GAD-7; SGB; anxiety; generalized anxiety disorder; stellate ganglion; two-level cervical sympathetic chain block; ultrasound.

Figure 1

Experimental pipeline used to complete patient enrollment, treatment, and analysis.

Figure 2

Decrease in GAD-7 scores after three months across all patients independent of severity and isolated by male (M) and female (F). Data modeled using raincloud plot with jiggering.

Figure 3

Severity-specific analysis of patient outcomes shows decrease in diagnosis categories 3M post procedure. Baseline (BL) and three-month (3M) scores are visualized across mild, moderate, and severe severity subgroups. This is seen across all severity groups with at least 50% improvement in anxiety-related symptoms. The figure includes a boxplot with CI, data jiggering, and the graphing of male and female data.

Figure 4

Boxplots with IQR and CI with jiggering to model repeated-measures ANOVA testing for BL and 3M GAD-7. Baseline (BL) and three-month (3M) scores are visualized across Mild, Moderate, Severe, and Average severity subgroups.

Figure 5

Raincloud plot modeling distribution of age with jiggering for each severity subgroup (mild, moderate, severe, and overall average). Sex-specific variables (male and female patients) are included in the data modeling.